Kidney News February 2018 10#2 : Page 1

Kidney News February 2018 | Vol. 10, Number 2 Microvascular Complications of Diabetic Kidney Disease Addressed in Report By Eric Seaborg kidney disease and says that the cause of disease is misdi-agnosed for many patients. “Vascular complications are the major cause of mor-bidity and mortality in diabetic patients,” according to “Diabetic Microvascular Disease: An Endocrine Society Scientific Statement.” The kidney, eye, and peripheral nervous system form the triad of “classical diabetes micro-vascular target tissues. Microvascular renal disease is … a major contributor to the development of end-stage kid-ney disease (ESKD) in the developed world.” The best practices in therapy are not a surprise. “The latest research shows that maintaining tight control over blood sugar levels and blood pressure can help to reduce the risk of complications such as diabetic nephropathy,” said Eugene J. Barrett, MD, PhD, of the University of Virginia, who chaired the task force that developed the statement. “Therapies to prevent or slow the development of DKD are multifactorial and include lowering blood sugar levels with medications, diet, and exercise, as well as treat-ing hypertension and hyperlipidemia,” the statement says. There are several medications that slow the progression of DKD, but they do not halt it, said Barry I. Freedman, MD, professor of internal medicine and chief of nephrol-ogy at Wake Forest School of Medicine, the lead author on the renal section of the statement. Agents that block the renin-angiotensin aldosterone system (RAAS), such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), are effective at slowing the progression of DKD in patients with high levels of proteinuria. New glucose-lowering agents, including sodium-glucose cotrans-porter-2 (SGLT-2) inhibitors and glucagon-peptide 1 (GLP-1) agonists, provide hope for slowing progression of established DKD or preventing its development. The statement reviews the various pathways to micro-vascular damage (see sidebar) and notes that some of the ef-fectiveness of medications may stem from disrupting these pathways. For example, ACE inhibitors may contribute not only by lowering systemic blood pressure, but could also decrease glomerular capillary pressure by inhibiting the kidney’s production of angiotensin II. Angiotensin II may lead to kidney damage through the induction of local factors, including extracellular matrix protein synthesis via transforming growth factor-b and inflammatory cytokines. Continued on page 2 I nnovative therapies and a better understanding of the underlying mechanisms of diabetic kidney dis-ease (DKD) are slowing its progression, according to a new Endocrine Society scientific statement on diabetic microvascular complications. The statement also describes the slow progress in finding genetic markers for diabetic > Method Could Help Monitor Transplant Referrals from Dialysis Clinics By Tracy Hampton Inside Findings Risk equation predicts outcomes in pediatric CKD F or patients with end stage renal disease (ESRD), barriers to kidney transplantation can come from a range of sources. Referral to a transplant center is an essential first step for patients who may be transplant candidates, and it’s one that relies on actions taken by the leadership and staff at dialysis centers. The Centers for Medicare & Medicaid Services, as well as the kidney community, have called for the development of quality measures for dialysis facilities to improve per-formance and equity in access to kidney transplantation, but little progress has been made. As described in a recent Clinical Journal of the American Society of Nephrology ar-ticle, a new method may be effective for assessing dialysis centers’ performance in this area. “In the past several years, the Centers for Medicare & Medicaid Services has focused on increasing referrals among dialysis facilities as part of the Statement of Work for the 18 End Stage Renal Disease Networks. However, these data are not routinely collected and are not available to the public to determine whether some dialysis facilities are appropriately referring patients for kidney transplanta-Continued on page 4 Transplant Innovations and Policy Increasing living donation; how well has KAS worked; normothermic perfusion to preserve organs, and where transplant may be headed > Policy Update Telehealth, AKI among ASN’s top policy targets in 2018 Industry Spotlight Products for contrast-induced AKI and stone assessment